A CASE OF PARADUODENAL HERNIA OPERATED ON UNDER A DIAGNOSIS OF STRANGULATION ILEUS

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 63; no. 2; pp. 383 - 386
• Main Authors: OTANI, Satoshi, INOUE, Hitoshi, MIURA, Jun-ichi, ITO, Fujio, KASHIMURA, Seigo
• Format: Journal Article
• Language: English
• Published: Japan Surgical Association 2002
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.63.383

A 49-year-old woman was seen at the hospital because of lower abdominal pain. She had had two laparotomies for appendicitis and cholelithiasis, respectively. After admission, the patient was given analgesics and followed. The abdominal pain gradually intensified and 6 hours after admission, abdominal distension on the right flank and muscle guarding in the right lower quadrant appeared. Abdominal CT scan revealed gathered ileus intestines in the right side of the retroperitoneum and ascites. Strangulation ileus was diagnosed and an emergency operation was performed. Upon laparotomy, the entire small intestines were impacted in the right side of retroperitoneum to be strangulated with the Treitz' ligament as a hernia orifice. The ileum, an efferent loop, presented severe congestion and a change in color, but the change was normalized when the ileum was soaked in warm physiological saline after it was reduced. So no intestinal resection was performed, and the hernia orifice was closed by sutures. The postoperative course was uneventful. Paraduodenal hernia is so rare that only 87 cases have been reported in the Japanese literature as far as we could review, and it presents difficulty in diagnosis preoperatively. In this case, characteristic findings should have been revealed on imaging, but it was difficult to differentiate the disease from ileus due to adhesion because of the patient's previous histories of undergoing laparotomies.